HIV Positive People with Acute Hepatitis C Infection Show Neurocognitive Impairment

		SUMMARY: HIV positive people with acute hepatitis C virus (HCV) coinfection showed evidence of impaired function based on magnetic resonance spectroscopy brain imaging and neurocognitive testing, according to a small U.K. study described in the June 2010 Journal of Viral Hepatitis. These findings suggest that the neurocognitive effects previously reported in people with chronic HIV/HCV coinfection may begin to happen soon after HCV acquisition.

By Liz Highleyman

Alan Winston from Imperial College London and colleagues sought to assess neurological and cognitive function in HIV positive people newly infected with HCV.

Central nervous system (CNS) manifestations of both chronic HIV and chronic hepatitis C have been widely reported, and impairment has been found to be worse when the 2 viruses co-exist. However, the study authors noted as background, the effects of acute HCV infection on the CNS in people with HIV are unknown.

This small analysis included 10 individuals with chronic stable HIV-1 infection with documented acute HCV, as indicated by a positive HCV RNA polymerase chain reaction assay but negative HCV antibody test. These patients were compared with 2 matched control groups: 10 people with HIV but no evidence of HCV, and 10 with no evidence of either HIV or HCV.

Participants underwent cerebral proton magnetic resonance spectroscopy (MRS) -- a technique for assessing brain function based on chemical signatures -- to quantify myo-inositol/creatine (mI/Cr) ratio in the right basal ganglia, which play a role in various brain functions including motor control. The patients also received computerized neurocognitive assessments.

Results

	Right basal ganglia mI/Cr ratio was significantly lower -- indicating impaired function -- in the HIV positive patients compared with the HIV-only and uninfected control groups (2.90, 3.34, and 3.43 respectively; P = 0.049.
	Half the participants in the acute coinfection group had a mI/Cr ratio below the lowest observed ratio in either of the other 2 groups.
	Neurocognitive testing revealed that the HIV positive acute hepatitis C group showed significant defects in the monitoring domain (P = 0.021).

Based on these findings, the study authors concluded, "Acute HCV in HIV-1 infected subjects is associated with CNS involvement."

Therefore, they recommended, "Clinicians should be vigilant of early CNS involvement when assessing subjects with acute HCV."

Investigator affiliations: Division of Medicine, Imperial College London, London, UK; Department of HIV Medicine, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK; Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK.

8/24/10

Reference
A Winston, L Garvey, E Scotney, and others. Does acute hepatitis C infection affect the central nervous system in HIV-1 infected individuals? Journal of Viral Hepatitis 17(6): 419-426 (Abstract). June 2010.